【摘要】 目的探讨小儿结核性脑膜炎的临床特点及早期诊断方法。方法回顾性分析2009年10月至2012年10月在我院确诊或临床诊断为结核性脑膜炎的68例住院患儿的临床资料。结果 68例病例中,男36例,女32例,年龄(4±4.35)岁。5例确诊病例,脑脊液结核杆菌培养阳性;63例为临床诊断病例。临床主要表现为:发热64例(94%);头痛和/或呕吐38例(56%);抽搐26例(38%);意识障碍33例(48%);脑膜刺激征阳性38例(56%);偏瘫27例(40%);25例伴颅神经损害,以动眼神经和外展神经受损为主。合并脑外结核47例(69%)。未接种卡介苗18例(27%),有明确肺结核接触史28例(42%)。脑脊液异常62例(92%),呈非化脓性改变,白细胞增高以淋巴细胞为主,蛋白质升高,糖、氯化物降低。头颅影像学有异常发现62例(92%),脑室扩张、交通性(梗阻性)脑积水和脑梗死最常见。全部病例均接受抗结核治疗,12例行侧脑室外引流术,其中11例转神经外科行脑室-腹腔分流术。好转或治愈62例(92%),后遗症28例(42%),自动出院2例(4%),死亡2例(4%)。结论该病临床表现复杂多样,早期症状和体征均缺乏特异性,仔细询问病史和结核接触史,结合脑脊液、头颅影像学、结核菌素试验是早期诊断的关键。更多还原

【Abstract】 Objective To explore the clinical features of pediatric tubercular meningitis and early diagnosis of this disease. Methods The clinical data of 68 children pathological or clinical confirmed as tubercular meningitis were retrospectively analyzed from October 2009 to October 2012. Results 36 cases were male and 32 were female.The median age was 4 ± 4. 35 years old. Cerebrospinal fluid tubercle bacillus of 5 cases was positive,and 63 children were clinically confirmed. The major clinic symptoms included fever( 64 /68),headache or vomit( 38 /68),seizures( 26 /68),coma( 33 /68),positive signs of meningeal irritation( 38 /68),paralysis( 27 /68) and 25 cases had neurological damage( oculomotor nerve and abducens nerve most frequent). Clinical staging showed 47 cases( 69%)were note extra-CNS TB. 27% children had not received BCG,and 42% cases had exposure to tuberculosis patients.CSF of 62 cases showed abnormalities,which were non-purulent,high classification of lymphocytes,high protein concentrations and low concentrations of glucose as well as chloride. Obvious abnormalities in brain CT or MRI were presented in 62 cases( 92%),such as ventriculomegaly,communicating / obstructive hydrocephalus and cerebral infarction. All isolates had accepted anti-TB treatment. 12 children underwent external ventricular drain,and 11 cases underwent ventriculoperitoneal shunt surgery. 62 cases had good outcome,but 28 children had neurological sequelae.2 cases of death reported( 4%). Conclusion The clinic features of pediatric tubercular meningitis is incomplete and the clinical findings are usually non-distinctive. The diagnosis of pediatric tubercular meningitis depends upon contact history,test of CSF,brain CT / MRI and tuberculin skin test.更多还原